Higher cumulative
viral load in the six months after diagnosis with HIV-related lymphoma is
associated with a subsequent increase in mortality risk, results of a large
observational study published in the online edition of AIDS show.

Investigators from the United States monitored people who
were alive six months after their lymphoma diagnosis for up to five years. Each
1 log10 increase in cumulative viral load during the first six
months after diagnosis was associated with a 35% increase in subsequent
mortality risk.

Cancers, including
lymphomas, remain an important cause of death among people with HIV. Early
antiretroviral therapy has been shown to improve outcomes for people
diagnosed with several HIV-related opportunistic infections and is therefore
recommended in disease management guidelines.

However, consensus
guidelines for the treatment of HIV-related lymphomas make no strong
recommendation for or against the use of antiretroviral therapy during chemotherapy for cancer. There are some concerns that the beneficial effects of HIV
treatment could be offset by an increased risk of interactions or drug-related
toxicities.

A team of
investigators from the United States wanted to get a clearer understanding of
the benefits of early HIV therapy for people with HIV who are diagnosed with lymphoma.

They therefore
reviewed the medical records of over 25,000 people who received care between
1996 and the end of 2011.

Analysis was
limited to the 224 people (1%) diagnosed with a lymphoma. All were alive six months after their diagnosis and had two or more
viral load measurements in this period. The investigators looked at the impact
of cumulative viral load in the six months after lymphoma diagnosis on survival
over five years. Cumulative viral load was selected as a marker of early and
effective HIV therapy.

The people in this group had a
median age of 43 years, 92% were male and 52% were white. Overall, 183 (82%)
were diagnosed with non-Hodgkin's lymphoma and 18% had Hodgkin's lymphoma.

At the lymphoma
diagnosis, the patients had a median CD4 cell count of 148 cells/mm3
and the median nadir CD4 cell count was 73 cells/mm3. Some 47% were taking HIV treatment at the time of diagnosis. The median overall
viral load was approximately 10,000 copies/ml but was undetectable (below 400
copies/ml) in a third of patients.

Each patient
contributed an average of three viral load measures during the six months after
their diagnosis.

Median cumulative
viral load for the entire study population over this period was 2.68 log10
copies x 6-months/ml. There were 64 people (29%) who maintained an
undetectable viral load throughout these six months.

The proportion of people in the group taking antiretroviral therapy increased from 47% at baseline to 58%
three months after lymphoma diagnosis and 71% six months after diagnosis.

There were 82
deaths during 851 person-years of follow-up, a mortality rate of 9.6 per 100
person-years.

Almost two-thirds
of patients were still alive five years after their diagnosis with lymphoma.

However, survival
rates differed according to cumulative viral load during the first six months
after diagnosis.

After five years,
54% of patients with a cumulative six-month viral load above the median
value were alive, compared to 70% of patients with a cumulative six-month viral
load below the median. This difference was statistically significant (p = 0.014).

The investigators
calculated that each 1 log10 increase in cumulative viral load
during the first six months after diagnosis was associated with a 35% increase
(95% CI, 1.11-1.65) in subsequent mortality risk between month six and year
five.

Older age and
lower CD4 cell count at the time of diagnosis were also associated with an
elevated mortality risk.

Further analysis
showed that viral load at the time of diagnosis was not associated with the
subsequent risk of death. However, viral load six months after diagnosis was. Each
1 log10 increase was associated with a 32% (95% CI, 1.12-1.56) increase
in mortality risk.

People with an
unsuppressed viral load during the first six months after cancer diagnosis were
64% (95% CI, 1.03-2.63) more likely to die during the study period than
people with an undetectable viral load during this six-month period.

“Increased viremia
during the six months after lymphoma diagnosis is associated with an increased
risk of death between six months and five years after diagnosis,” comment the
investigators. They believe the consistent relationship between viral load and
increased mortality risk shows that “effective ART during chemotherapy may
improve overall survival”.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends
checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.